1

pharmacy Bulletin

PKD Melaka Tengah

ADVISOR

Dr. Rusdi Bin Abd. Rahman

EDITOR-IN-CHIEF

Lee Mei Lin

EDITOR

Chew Poh Chiong

EDITORIAL TEAM

Michelle Lim Bee Ping

Noorafinah

Foo Swee Yen

Syahirah

EDITORIAL BOARD

Edition 2/2015

What’s Inside

Vaccination in Children

page 02

Needle Prick Injury

page 07

Value Added Services (VAS)

of Dispensing Medicine

page 12

Antiretroviral Drug Dispensing in Prison

page 19

Drug Comparison:

PPI and H2-antagonist

page 21

Updates in the Categories of Drugs listed in

MOH Drug Formulary 2015

page 23

Truth @ Myths:

Vitamin C Injection for

Enhancement of Beauty

page 24

2

What is immunization? Immunization is an attempt to replace the anticipated

natural primary contact between the human body and

a hostile organism, with a safer artificial contact, so

that any subsequent natural contact takes place in a

state of heightened immunity.

Introduction Vaccines have helped save millions of children’s lives

compared to other public health or medical initia-

tives. Just a few generations ago, people lived under

the constant threat of deadly infectious diseases, like

smallpox, polio, hepatitis, measles, etc. Centers for

Disease Control and Prevention estimates that vacci-

nations prevent more than 21 million hospitalizations

and 732,000 deaths among children born in the last

20 years in United States alone. While in Malaysia,

incidence of pertussis has been less than 1 per 100

000 populations for the past 15 years according to

Disease Control Division, Department of Public

Health, Ministry of Health (2010)(1). It is attributed by

the good immunization coverage. There were signifi-

cant reduction in mortality and morbidity in Malaysia.

Rising of anti-vaccines group However, the anti-vaccine lobby gains ground and

tends to voice out their protests recently. According

to Dr. Suhaimi, a Family Management Specialist from

Ayer Keroh Health Clinics; the anti-vaccines group in

Malaysia is increasing in number but their impact on

society is minor. The rise of anti-vaccine group is

mainly due to misunderstanding of the information

they are given about vaccines and influences from so-

cial media. Anti-vaccines groups existed because they

have a principle that vaccines are harmful to their

children. Dr. Suhaimi also mentioned, in order to

help the anti-vaccines groups understand the impor-

tance of vaccines, we should educate them by provid-

ing correct information with the aim to prevent the

spread of negative things about vaccines.

The Benefits of Vaccine Far Outweigh

the Risks (2)

1. Vaccination saves lives.

The primary benefit of vaccination is that it pre-

vents disease. In one year, vaccines prevent more

than 8,500 child hospitalizations in Colo-

rado, 33,000 deaths in the U.S., and between 2

and 3 million deaths worldwide.

2. Vaccination protects the people you care

about.

Vaccinated community helps to protect those

who are not vaccinated, a concept known as

“herd immunity” or “community immunity.”

When a person is vaccinated, they prevent dis-

ease from being spread to others in the commu-

nity, including:

Babies too young to receive vaccines

Unvaccinated children and adults

Pregnant women

The elderly

Individuals with weakened immune sys-

tems (chronic illness or chemotherapy

patient)

Individuals who are allergic to vaccine

components

3. Vaccines are cost effective.

It is always cheaper to prevent a disease than to

treat it. The routine childhood immunization

program in one birth cohort saves $13.6 billion in

direct costs.

4. Vaccines are safe.

Vaccines undergo rigorous safety testing prior to

being approved by the Food and Drug

Administraton (FDA) and are

continually monitored for safety.

by Aqilah bt. Abd Rahman & Nurul Nadia Bashir

Vaccination

In Children

3

ABOUT

VACCINATION (3)

Fact 1: Vaccines interact with the immune system to produce an immune response similar to that pro-

duced by the natural infection, but they do not cause the disease or put the immunized person at risk of

its potential complications. In contrast, the price paid for getting immunity through natural infection might

be mental retardation from Haemophilus influenzae type b (Hib), birth defects from rubella, liver cancer

from hepatitis B virus, or death from measles.

Fact 2: Scientific evidence shows that giving several vaccines at the same time has no adverse effect on a

child’s immune system. Children are exposed to several hundred foreign substances that trigger an im-

mune response every day. Key advantages of having several vaccines at once is fewer injection and fewer

clinic visits, which saves time and money, and children are more likely to complete the recommended vac-

cinations on schedule.

Fact 3: Vaccines are very safe. Most vaccine reactions are usually minor and temporary, such as a sore arm

or mild fever. Very serious health events are extremely rare and are carefully monitored and investigated.

Benefits of vaccination greatly outweigh the risk. You are far more likely to be seriously injured by a

vaccine-preventable disease than by a vaccine. For example, in the case of polio, the disease can cause pa-

ralysis, measles can cause encephalitis and blindness, and some vaccine-preventable diseases can even

result in death.

Fact 4: Thiomersal is an organic, mercury-containing compound added to some vaccines as a preservative.

It is the most widely-used preservative for vaccines that are provided in multi-dose vials. There is no evi-

dence to suggest that the amount of thiomersal used in vaccines poses a health risk.

Fact 5: There is no evidence of a link between MMR vaccine and autism or autistic disorders. The 1998

study which raised concerns about a possible link between measles-mumps-rubella (MMR) vaccine and

autism was later found to be seriously flawed, and the paper has been retracted by the journal that pub-

lished it.

Fact 6:Many infections can spread regardless of how clean we are. Better hygiene, hand washing and clean

water help protect people from infectious diseases. But if people are not vaccinated, diseases that have

become uncommon, such as polio and measles, will quickly reappear.

Fact 7: Although vaccine preventable diseases have become uncommon in many countries, the infectious

agents that cause them continue to circulate in some parts of the world. These agents can cross geo-

graphical borders and infect anyone who is not protected.

Myth 1: It is better to be immunized through disease than through vaccines. --- FALSE

Myth 2: Giving a child more than one vaccine at a time can increase the risk of harmful side

-effects, which can overload the child’s immune system. --- FALSE

Myth 3: Vaccines have several damaging and long-term side-effects that are yet unknown.

Vaccination can even be fatal. --- FALSE

Myth 4: Vaccines contain mercury which is dangerous. --- FALSE

Myth 5: Vaccines cause autism. --- FALSE

Myth 6: Better hygiene and sanitation will make diseases disappear, vaccines are not neces-

sary. --- FALSE

Myth 7: Vaccine-preventable diseases are almost eradicated, so there is no reason to be

vaccinated. --- FALSE

4

Immunisation Schedule in Malaysia (4)

NEW UPDATE!

The schedule for the additional dose of DtaP-IPV-HiB 5-in-1 vaccine mandatory for infants in

Malaysia at 18 months has been deferred to 24 months due to the shortage of the vaccine. (5)

5

Types of Vaccines(6)

Immunisation Details

BCG BCG, or bacille Calmette-Guerin, is a vaccine for tuberculosis (TB) disease.

Many foreign-born persons have been BCG-vaccinated. BCG is used in

many countries with a high prevalence of TB to prevent childhood tubercu-

lous meningitis and miliary disease.

Hepatitis B Hepatitis B is a contagious liver disease that ranges in severity from a mild

illness lasting a few weeks to a serious, lifelong illness. It results from infec-

tion with the hepatitis B virus. The best way to prevent hepatitis B is by

getting the hepatitis B vaccine. The hepatitis B vaccine is safe and effective

and is usually given as 3-4 shots over a 6-month period.

Diphteria Diphtheria is a respiratory disease caused by bacteria that causes a thick

covering on the back of the throat. The symptoms include, gradual onset of

sore throat and low-grade fever

It can lead to breathing problems, paralysis, heart failure, and even death..

Diphtheria is spread person-to-person by coughing and sneezing.

Hib Hib bacteria (Haemophilus influenzae type B) can cause severe infections

such as meningitis and is spread through contact with mucus or droplets

from the nose and throat of an infected person, often by coughing or

sneezing. Most of the time, Hib is spread by people who have the bacteria

in their noses and throats but who are not ill (asymptomatic).

All children younger than five years of age should be vaccinated with Hib

vaccine, because infants and very young children are most vulnerable to Hib

disease. There is little risk of getting disease after age five.

OPV Poliomyelitis (polio) is a highly infectious disease caused by a virus that in-

vades the nervous system. Polio is an infectious disease caused by a virus

that lives in the throat and intestinal tract. It is most often spread through

person-to-person contact with the stool of an infected person and may also

be spread through oral/nasal secretions (such as saliva).

Measles Measles is a respiratory disease caused by a virus. Measles starts with fever,

runny nose, cough, red eyes, and sore throat. It’s followed by a rash that

spreads over the body. It can lead to complications, such as ear infection,

diarrhea, pneumonia, brain damage, and death.

MMR MMR is a safe and effective combined vaccine that protects against three

separate illnesses – measles, mumps and rubella (german measles) – in a

single injection.

Measles, mumps and rubella are common highly infectious conditions that

can have serious, and potentially fatal, complications, including meningitis,

swelling of the brain (encephalitis) and deafness.

6

Immunisation Details

Rubella Rubella is an infectious disease caused by a virus. It is also known as German

measles or three-day measles, but it is not the same disease as measles. Young

children who get rubella usually have a mild illness, with symptoms that can in-

clude a low-grade fever, sore throat, and a rash that starts on the face and

spreads to the rest of the body. Older children and adults are more likely to

have a headache, pink eye, and general discomfort before the rash appears.

Tetanus Tetanus is an infection caused by bacteria. When the bacteria invade the body,

they produce a toxin, or poison, that causes painful muscle contractions. Teta-

nus infection mainly affects the neck and abdomen. Tetanus is also called

"lockjaw" because it often causes a person's neck and jaw muscles to lock, mak-

ing it hard to open the mouth or swallow. It can also cause breathing problems,

severe muscle spasms, seizures, and paralysis.

References

1. Case Investigation and Outbreak Disease Control Division, Department of Public Health, Ministry of Health, 2010, 1st Edi-tion

2. Colorado Children’s Immunization Coalition (CCIC). Benefits vs. Risks. Of Vaccination [Retrieved on 10 December 2015 from http://www.immunizeforgood.com/fact-or-fiction/benefits-vs.-risks ]

3. WHO. What are some of the myths – and facts – about vaccination? [Retrieved on 10 December 2015 from http://www.who.int/features/qa/84/en/]

4. WHO. (2002). Fakta Imunasasi Kanak-kanak bagi Kakitangan Kerajaan. [Retrieved from http://www.infosihat.gov.my/infosihat/media/garis_panduan/I/pdf/03_imunisasiKanak_BM.pdf]

5. The Malaysian Insider. Schedule for additional dose of 5-in-1 immunisation deferred to 24 months. [Retrieved on 10 De-cember 2015 from http://www.themalaysianinsider.com/malaysia/article/schedule-for-additional-dose-of-5-in-1-immunisation-deferred-to-24-months#sthash.uC6fJDUc.dpuf ]

6. U.S. Department of Health and Human Services. Types of vaccines. [Retrieved on 10 December 2015 from http://www.vaccines.gov/more_info/types/]

7. Infomed Malaysia. Vaccination in Malaysia. [Retrieved on 10 December 2015 from http://infomed.com.my/vaccination-in-malaysia]

(7)

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Needle Prick Injury by Low Li Ying

INTRODUCTION

Needlestick injury is the most common form of injuries amongst healthcare workers (HCW). In Malaysia, Occupa-

tional Health Unit of Ministry of Health had reported an incidence rate of 4.7 needlestick injuries per 1,000 HCW in

2005. All HCW are at risk of bloodborne infections after an occupational exposure, such as Hepatitis B Virus (HBV),

Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) infection. National Institute of Occupational

Safety and Health (NIOSH, 1999) reported that the rate of HBV transmission to susceptible HCW ranges from 6% to

30% after a single needlestick exposure to an HBV-infected patient. Prospective studies of HCW exposed to HCV

through needlestick injuries have found that the incidence of anti-HCV seroconversion averages 1.8% (range 0% to

7%) per injury. For HIV infection, the average risk of post needlestick exposure to HIV-infected blood is 0.3% or 1 in

300 (CDC 1991).

NEEDLESTICK INJURIES IN PHARMACY

Many medicines are administered by injection, particularly in hospitals, clinics and by patients themselves. These

medicines include intravenous infusions, insulin, etc. Although the incidence of needle stick injuries in pharmacy

profession is low, it is also crucial for pharmacy staff to take preventive measurements to minimize the risk of

needlestick injuries. Pharmacists are exposed to such risk when we counsel patient on insulin injection technique

where the use of insulin needle is required. Besides that, such injuries also often occurred when dealing with pa-

tient’s returned medication. Some patient might dispose their used insulin needles in the waste bag together with

their old medication. Hence, it is our responsibility to educate patients regarding safe disposal of sharps needles.

MANAGEMENT

Work Process on the Management of Occupational Exposures to HIV, HBV and HCV amongst HCW

8

Guidelines for HIV PEP (Post Exposure Prophylaxis)

Determining the Need for HIV Post Exposure Prophylaxis (PEP) After an Occupational Exposure

STEP 1: Evaluation of the Exposure (Chart 1)

9

STEP 2: Determine the HIV Status of the Source (Chart 2)

STEP 3: Determine the PEP Recommendation (Table 2 & 3)

Recommended HIV Post Exposure Prophylaxis (PEP) for mucous membranes exposures and non-

intact skin exposures (Table 2)

*The recommendation to “consider PEP” indicates that PEP is optional; a decision to initiate

PEP should be based on a discussion between the exposed person and the treating clinician re-

garding the risks versus benefits of PEP.

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Recommended HIV Post Exposure Prophylaxis (PEP) for percutaneous injuries

(Table 3)

Regimen Category and Drug Regimen

HCW should be advised:

(a) Not to donate plasma, blood, body tissue, breast milk or sperm

(b) To protect sexual partners by adopting safe sexual practices (e.g. use of condoms)

(c) To consult the Head of Department regarding the need to modify work practices involving

EPP if he/she develops clinical or serological evidence of HIV infection.

During the follow up, the HCW should be retested for anti-HIV (ELISA) at 6 weeks, 3 months and

6 months.

11

RECOMMENDED POST EXPOSURE PROPHYLAXIS (PEP)

FOR EXPOSURE TO HEPATITIS B VIRUS

PREVENTION 1. All HCW should be informed, educated and trained on the following:

a. The possible risks and prevention of blood borne infections after an occupational exposure.

b. The measures needed to prevent blood borne pathogen exposures: Implementation of standard precautions. Provision of personal protective equipment and safety devices. Implementation of safer procedures.

c. HBV vaccination. d. The principles of post-exposure management and the importance of seeking im-

mediate advice following any occupational exposure. 2. All HCW should be informed and trained on the above matters before they are allowed

to handle sharps, blood and hazardous body fluids.

REFERENCE: 1. Occupational Health Unit, DCD, MOH (2007). Guidelines on Occupational Exposures to

Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) and Hepatitis C Virus and Recommendations for Post Exposure Prophylaxis (PEP).

12

by Nurul Ain

Value Added Service

(VAS)

Of Dispensing Medicine

Introduction

I n line with the powerful slogan of MOH "Kami Sedia Membantu", pharmacy department has brought innovation

towards the transformation of service delivery systems and processes. Pharmacotherapy accessibility, especially for

patients with chronic diseases is a paramount importance to MOH in order to maintain quality of life and reduce

the cost of life long health. Therefore, it is crucial for Pharmacy department to maintain current system of drugs supply

to be compatible with the current facilities and meet the needs of people at an optimal level.

As to improve the Quality Use of Medicines (QUM) among the public, partial drug supply is given for a chronic diseases

prescription with one month and the next supply can be made using Value Added Services (VAS).

Objective 1. To give alternative means for patients to collect their medication

2. To ensure continuous supply of patient’s medication

3. To improve patient’s compliance towards medication

VAS is offered through various types of Pharmacy Appointment System (PhAS):

1. Integrated drug dispensing system / Sistem Pendispensan Ubat Bersepadu (SPUB)

2. Medicines by Post 1Malaysia/Ubat Melalui Pos 1Malaysia (UMP1M)

3. Appointment System / Sistem Temujanji

4. Drive-thru Pharmacy

5. Farmasi Susulan Secara Temujanji (FaST)

6. Letak dan Ambil

DELIVERY SELF COLLECTION COST

SPUB - Collect follow-up medicines at any MOH pharmacy according to patient’s preference.

-

UMP1M Follow-up medicines is deliv-ered to address given by patient.

- RM 5 shall be paid to Pos Malaysia staff upon deliv-ery of the package.

IMED - Collect follow-up medicines at date given where medicines will be pre-pared beforehand.

-

DRIVE-THRU - Collect follow-up medicines at Drive-thru pharmacy, Hospital Melaka. [Available at KK Peringgit only]

-

FaST - Collect follow-up medicines at Ba-hagian Perkhidmatan Farmasi, JKNM.

-

LETAK DAN

AMBIL

- Patient leave their prescription at phar-macy counter and collect medicines at convenience time.

-

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i) Integrated drug dispensing system / Sistem

Pendispensan Ubat Bersepadu (SPUB)

Integrated Drug Dispensing System (SPUB) is a standardized and

well-organized reference method for the partial supply of medi-

cations. Patients can get supplies of follow-up medicines at any

MOH pharmacy close to their homes or workplace and patients

will receive the same quality of service at any facility choice via a

standard reference method. By choosing this method of collect-

ing medicines, patient can save more time and money.

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ii) Medicines by Post 1Malaysia/Ubat

Melalui Pos 1Malaysia (UMP1M)

As a result of cooperation between MOH and Pos Malaysia Ber-

had, UMP1M is introduced to enable patient’s follow-up medi-

cations supply to be delivered directly to the patient's preferred

location with predetermined post charges. This service will save

patient’s time and money as patient no longer need to go over

the pharmacy counter to take the follow-up medicines. Hence,

patient will not experience parking problem as well. However,

this services is limited to certain medications, where only medi-

cine in tablet or capsules dosage form, with no special storage

condition and non-psychotropic drugs are allowed.

15

iii) Appointment System / Sistem Temujanji

Appointment system, also known as instant medicine (IMED) in PKDMT allows patient to collect

their balance medications on the appointed date. This service offers shorter waiting time for pa-

tients as their medications will be prepared before the appointment date. Besides that, this service

can reduce congestion in pharmacy waiting areas during peak hours.

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iv) Drive-thru Pharmacy

This service has been introduced in selected hospitals and health clinics for patient’s convenience

because patient can claim their medications directly at drive-thru pharmacy counter with no wor-

ries of parking space availability. Patient also can get their medica-

tion faster because their medications was pre-prepared before pa-

tient’s appointment date. Hence, this service can avoid congestion

in pharmacy waiting areas. To date, in Malacca, this service is avail-

able only in Klinik Kesihatan Peringgit and Hospital Melaka.

17

v) Farmasi Susulan Secara Temujanji (FaST)

This service enables patients to take their follow-up medication supply at Bahagian Perkhidma-

tan Farmasi, Jabatan Kesihatan Negeri Melaka. This service is only applicable for patients from

hospitals or klinik kesihatan in Melaka with prescriptions more than one month supply who lives

or work nearby Jabatan Kesihatan Negeri Melaka. Health facilities that refer patient will prepare

medications together with SPUB form and send it to Jabatan Kesihatan Melaka on Monday and

Tuesday, while medications are ready to be collected from Wednesday to Friday.

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vi) Letak dan Ambil

This service enables patients to take their medication supply without waiting for a long time. Af-

ter taking a number, patient can leave their prescription at pharmacy counter (letak) and collect

their medications later when convenience (ambil). This service is able to reduce congestion in

pharmacy waiting areas during peak hours and provides flexibility to patient to collect their

medication at convenient time.

CARTA ALIR AKTIVITI LETAK DAN AMBIL

PF/PPF

PF/PPF

PF/PPF

PF/PPF

Pesakit mendaftar dan mengambil nombor di kaunter

dan memaklumkan kepada petugas untuk mendapatkan

ubat kemudian.

Petugas memberi nombor kaunter khas dan menghantar

preskripsi untuk diisi dan dilabel.

Ubat yang telah disiapkan akan diasingkan di dalam

kotak khas serta nama pesakit didaftarkan di dalam buku

daftar. Nombor giliran pesakit akan ditekan terlebih da-

hulu walaupun ubat pesakit masih belum dituntut.

Ubat pesakit diserahkan apabila pesakit datang membuat

tuntutan ubat. Bagi ubat yang tidak dituntut, pesakit akan

dihubungi selepas 3 hari untuk datang mengambil ubat.

Ubat yang tidak dituntut akan disimpan sehingga tempoh

2 minggu sebelum dikembalikan semula ke rak ubat.

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HIV Treatment Program is currently available at Sungai Udang Prison. This program is led by

Dr. Nor Hayati binti Shaharuddin, Infectious Disease Specialist from Hospital Melaka. The team con-

sists of Infectious Disease (ID) Specialist, Medical Officers (MO), Infectious Disease Trained Counsel-

lors, Medical Assistants (MA) and Pharmacists. For the time being, visits are scheduled 2 times in a

month, which start at 9.00 am and finish at noon around 1.00 pm.

The objectives of the program in the view of pharmacy are:

i) To optimize the therapy of HAART and other therapies related to HIV patients.

ii) To help patient to recognize and manage adverse drug effects.

iii) To serve as information resource.

iv) To collaborate with other healthcare professionals in managing HIV patients.

It is prison’s policy that every new prisoner must be screen for HIV. HIV positive prisoners will be

identified by MAs and will be referred to either ID Specialist or MOs for further management. The

decision to start or continue HAART is done by doctors, depended on patient’s CD4 count. If there

are patients newly started on HAART, or switching to new regimen or identified compliance prob-

lems, they will be referred to pharmacist.

By Mohamad Hatta & Saiful Adlan

P risons are a high-risk institution for human immunodeficiency virus (HIV) transmission

where drug use, high-risk sex and rape is common. Yet, prisoners’ wellbeing are often ne-

glected and overlooked. HIV treatment program are rarely made available to them, thus making

many prisoners with HIV unable to access to their antiretroviral medications.

Cooperation from all team members of HIV Treatment Program is crucial to

ensure best treatment outcome. It is extremely important that counselling

for HIV positive patients is done properly so that patient receive optimal

HAART management. Compliance and adherence have been the main

challenges in HAART management. Strict adherence to HAART is the key

to sustained HIV suppression, reduced risk of drug resistance, improved

overall health, quality of life, and survival.

20

Pre packing All the drugs will be pre packed into weekly basis.

Dispensing Dispensing will be done to patients newly started on HAART and Isoniazid

Preventive Therapy (IPT), while those already on treatment will be supplied

by Medical Assistant.

Counselling Counselling will be given to new patients, patients requiring changes in

HAART regimen and patients with adherence problems. Counselling sessions

will basically cover pre-HAART, HAART, post-HAART and IPT

(occasionally).

Supplying

medications

Pharmacists will make sure that patients’ medication supplies are enough at

all times.

Providing drug

information

Pharmacist will assist other healthcare professionals in term of drug informa-

tion whenever needed.

Stock

procurement

Pharmacist will order HAART medications from Hospital Melaka whenever

needed.

Roles of pharmacist in HIV Treatment Program:

The counselling are usually divided into 3 parts:

Review case notes

Document in case

notes

Counsel patient

Assess data & medi-

cation history

Assess readiness for

HAART

Reassess beliefs, percep-

tions and compliance

End

Pre HAART

Review case notes

Document in case

notes

Counsel patient

Assess data & medi-

cation history

End

HAART

initiated

Review case notes

accordingly

Document in case

Counsel patient

Assess data & medica-

tion history

Assess compliance &

adherence

Patient review by

doctor

End

Post HAART

Select patient to be

counselled

REFERENCES: 1. MOH (2011). Guideline for The Management of Adult HIV Infection with Antiretroviral Therapy 2. MOH (2010). Retroviral Disease (Medication Therapy Adherence Clinic and Ward Pharmacy). 1st Ed.

21

Drug Comparison:

PPI and H2-antagonist

By: Woon Su Ann

H2-antagonist Proton pump inhibitor (PPI)

Ranitidine Omeprazole Pantoprazole

Mechanism of action (MOA)1

Competitive inhibition of histamine at H2-receptors of the gastric parietal cells, hence reduce gastric acid secretion. Does not affect pepsin se-cretion, pentagastrin-stimulated intrinsic factor secretion or serum gastrin.

Inhibit H+/K+ ATPase en-zyme in gastric parietal cells, hence suppress gastric acid secretion.

Inhibit H+/K+ ATPase enzyme in gastric parietal cells, hence suppress gastric acid secre-tion.

Prescriber category2

B A/KK A*

Indication & Dosage2

Reflux oesophagitis

150mg BD or 300mg ON for 8-12weeks

Reflux oesophagitis

20-80mg OD/BD up to 8-12weeks

Erosive and non-erosive re-flux oesophagitis (GERD & NERD) 20-40mg OD for 4 weeks

Zollinger-Ellison syndrome

150mg up to max 6g/day

Zollinger-Ellison syndrome

Adult: 20-120mg OD

Child: 0.4-0.8mg/kg/day

Zollinger-Ellison syndrome

40mg BD. Max:240mg OD

22

H2-antagonist Proton pump inhibitor (PPI)

Ranitidine Omeprazole Pantoprazole

Indication & Dosage2 Benign gastric & duo-

denal ulcer

150mg BD or 300mg ON for 4-8weeks. Mainte-nance:150-300mg OD

Benign peptic ulcer not responding to conven-tional therapy

20mg OD for 4-6weeks

Peptic ulcer disease

40mg OD for 2-4 weeks

Non-ulcer dyspepsia

150mg BD or 300mg ON for 8-12weeks

Helicobacter pylori eradication

20mg BD with combina-tion of 2 antibiotics (clarithromycin 500mg BD, amoxicillin 1g BD or metronidazole 400mg BD) for 1-2weeks

Helicobacter pylori eradication

40mg BD with combina-tion of 2 antibiotics (clarithromycin 500mg BD, amoxicillin 1g BD or metronidazole 400mg BD) for 1-2weeks

Prevention of NSAID induced gastropathy

20mg OD

(Not recommended in children)

Administration1 Unaffected by food Before meals Before meals

Onset of action1 - 1hour (anti-secretory) -

Time to peak1 Oral: 2-3 hours

IM: <15minutes

Within 2 hours Oral: 2.5 hours

Common side effect1 0-10% Cardioavascular:

Bradycardia (<4%) hypotension (<4%) palpitation(<4%) Central nervous sys-tem: headache (<6%) confusion (<4%)

1-10% Central nervous system: headache (7%) dizziness (2%) Gastrointestinal: ab-dominal pain (5%), diar-rhea (4%)

1-15%

Central nervous system: headache(12%), dizzi-ness (4%) Cardiovascular: facial edema (4%)

Price2 RM 0.13/tab RM 0.50/capsule RM 0.50/tab

Cost per 6 weeks of therapy

RM 10.92 (150mg BD) RM 21.00 (20mg OD) RM 21.00 (40mg OD)

Reference:

1. William J, Matthew A, Morton P et al. American Pharmacists Association. Drug Information Handbook, Lexicomp

Drug Reference Handbook. 22nd ed.

2. Melaka Drug Formulary Committee. Pharmaceutical Services Division. Drug Formulary Melaka 2014/2015.

23

by Nadiah Mohd Mohtar

Updates in the Categories of Drugs

listed in MOH Drug Formulary 2015

No. Generic Name Old Category

New Category

Indication Price (RM)

1. Atorvastatin 20mg, 40mg, 80mg Tablet

A* A/KK Hypercholesterolaemia and coronary heart dis-ease intolerant or not responsive to other forms of therapy

0.12(20mg), 0.22(40mg), 0.34(80mg)

2. Terazosin HCL 1mg, 2mg, 5mg Tablet

A A/KK a)1mg: Only for treatment of Benign Prostatic Hyperplasia. Not to be used for treatment of hyperten-sion

0.18(1mg), 0.21(2mg), 0.31(5mg)

b)2mg & 5mg:

i) Treatment of Benign Prostatic Hyperplasia. ii) Hypertension

3. Ketoconazole 2% Shampoo

A A/KK Resistant dandruff only

9.00

4. Ofloxacin 0.3% Otic Solution

A A/KK Acute otitis media with tympanostomy tubes, chronic suppurative otitis media with perfo-rated tympanic membranes and otitis externa

9.65

5. Omeprazole 10mg, 20mg Tablet

A A/KK Only for : i) Reflux oesophagitis ii) For eradication of Helicobacter pylori infec-

tion iii) Benign peptic ulcer not responding to con-

ventional therapy iv) Zollinger -Ellison Syndrome

0.29(10mg), 0.44(20mg)

6. Terbinafine HCL 250mg Tablet

A* A/KK Fungal infections especially onchomycosis caused by dermatophytes

1.00

7. Tretenoin 0.01% Gel

A A/KK Acne vulgaris, recalcitrant cases of acne (comedonal type)

20.70

8. Diclofenac So-dium 75mg/3ml Injection

A A/KK Pain and inflammation in rheumatic disease 0.36

9. Fenofibrate 145mg Tablet

A* A/KK As second line therapy after failed gemfibrozil in patients: i) Hypercholesterolemia and hypertriglyc-

eridemia alone or combined ii) Treatment of secondary hyperlipoproteine-

mias iii) Dyslipidemia in Type 2 Diabetes Mellitus

1.00

References: 1. Senarai FUKKM. (7 December 2015) [Retrieved from http://www.pharmacy.gov.my/v2/ms/apps/fukkm ] 2. MOH Drug Formulary 2014

***Changes do not reflect immediate inclusion into the district formulary. Such drugs will still need to undergo

assessment of usage by district JKTU.

24

Vitamin C Injection for

Enhancement of Beauty By Nur Farahin Abdul Jabar

Vitamin C is a commonly used nutritional supplement. It has numerous well-known health

benefits, include protection against immune system deficiencies, cardiovascular disease,

prenatal health problems and also eye disease. Hence, this causes the global market

flooded with Vitamin C fortified foods. Besides consuming Vitamin C orally, Vitamin C injec-

tion has received a great deal of attention on its role in enhancement of beauty.

POTENTIAL ROLE OF VITAMIN C INJECTION FOR ENHANCEMENT OF BEAUTY

POTENTIAL MECHANISM OF ACTION OF VITAMIN C

25

SAFETY AND EFFICACY STUDIES

There was no significant clinical evidence to prove that vitamin C injection can improve skin

elasticity (anti-ageing and anti-wrinkle) and whiten the skin. Although there was a laboratory

study that showed the potential effect of vitamin C to improve skin elasticity, the study was

low level of evidence. In additions, the safety of vitamin C injection for cosmetic purposes was

inconclusive due to lack of clinical data retrieved.

No USFDA approval of vitamin C injec-

tion for cosmetic purposes

Any kind of Vitamin C injection for cos-

metic used is prohibited by NPCB.

CONCLUSION

Vitamin C injection is not recommended to be used for cosmetic due to lack of clinical evidence and safety data.

REFERENCES

1. Vitamin C Injection for Cosmetic. Health Technology Assessment Section (MaHTAS), Medical Development Division, MOH. 011/2012

2. Park HJ, Ock SM, Kim HJ et al. Vitamin C Attenuates ERK Signalling to Inhibit the Regulation of Collagen Production by LL-37 in Human Dermal Fibroblasts. Experimental Dermatology. 2009; 19: e258-e264.

3. Padayatty SJ, Sun AY, Chen Q et al. Vitamin C: Intravenous Use by Complementary and Alternative Medicine Practitioners and Adverse Effects. PLoS ONE. 2010; 5(7): e11414.